| NPI | 1770579096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 25271) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25271) |
| 207Q00000X Family Medicine (Licence: NY 150540) | |
| 207P00000X Emergency Medicine (Licence: KS 04-34052) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2016-09-14 |