| NPI | 1508055690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 26891) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R1341) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2017-04-05 |