| NPI | 1821257577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 50432) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 101254876) |
| Enumeration Date | 2008-06-07 |
| Last Update Date | 2025-12-09 |