| NPI | 1588621627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 18449) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2022000630) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-03-08 |