| NPI | 1679836035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0057191) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2012017704) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2016-07-15 |