| NPI | 1871711036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CO 46265) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1333) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2021-03-29 |