| NPI | 1376070383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 37479) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-46606) |
| 207Q00000X Family Medicine (Licence: IA R-10811) | |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2022-09-01 |