| NPI | 1164865036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5619) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA DO.311332) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2020-09-28 |