| NPI | 1912057647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0052821) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 64728) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2013-08-21 |