| NPI | 1710220595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0058342) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 1710220595) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-31 |
| Last Update Date | 2021-05-04 |