| NPI | 1255399309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J1613) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 17271) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX J1613) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OK F26889) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-07-27 |