| NPI | 1922741768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0072149) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO DR.0072149) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2025-09-03 |