| NPI | 1871854505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.055100) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM nm2017-0114) |
| 207P00000X Emergency Medicine (Licence: NM MD2017-0114) | |
| 207P00000X Emergency Medicine (Licence: NC 183280) | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2024-06-27 |