| NPI | 1366718553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 39886) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-9663) |
| 207Q00000X Family Medicine (Licence: NM RS2014-0277) | |
| Enumeration Date | 2012-04-01 |
| Last Update Date | 2022-07-26 |