| NPI | 1689109605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY TP017) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 7502) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2024-04-11 |