| NPI | 1902815160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 26121) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 33071) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AZ 33071) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-06-02 |