| NPI | 1760841423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: CO DR.0076363) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2026-0092) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2026-03-24 |