| NPI | 1962479063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 43310) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 43310) |
| 207P00000X Emergency Medicine (Licence: NM A-1353-06) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2014-09-17 |