| NPI | 1558627125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 48644) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 29179) |
| Enumeration Date | 2012-04-07 |
| Last Update Date | 2022-12-19 |