| NPI | 1164848982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 5556) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 0013R) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2014-06-25 |