| NPI | 1982689972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 42410) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 75418) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2025-01-14 |