| NPI | 1750739371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 267822) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 267822) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2021-05-04 |