| NPI | 1528475944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 5789) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 0056R) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2022-06-02 |