| NPI | 1124088661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OK 22910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 22910) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2017-05-12 |