| NPI | 1730759507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 7628) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 0467R) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2022-09-27 |