| NPI | 1376563163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 23053) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 23053) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2016-05-25 |