| NPI | 1912262197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 32855) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK Q5966) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2017-11-10 |