| NPI | 1548365117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 03095) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OK 3095) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2014-10-20 |