| NPI | 1063892529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AR E-11984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 31420) |
| Enumeration Date | 2015-05-31 |
| Last Update Date | 2019-06-24 |