| NPI | 1982720348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2010-0141) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2010-0141) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CO 33059) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2019-12-16 |