| NPI | 1790703999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 6738) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2006-00363) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-06-17 |