| NPI | 1871120337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0071612) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101274079) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2023-07-30 |