| NPI | 1730210733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID MC-0362) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO CDRH.0045573) |
| 207P00000X Emergency Medicine (Licence: AZ 58357) | |
| 207P00000X Emergency Medicine (Licence: NV 18674) | |
| 207P00000X Emergency Medicine (Licence: CO 45573) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-05-15 |