| NPI | 1205147998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OK 6118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 6118) |
| 207Q00000X Family Medicine (Licence: AR 18608) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2025-07-15 |