| NPI | 1659682953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301096226) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 28808) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2025-01-24 |