| NPI | 1245537158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 5428) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.010435) |
| Enumeration Date | 2011-02-12 |
| Last Update Date | 2018-10-12 |