| NPI | 1922094184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: OK 4123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4123) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2022-01-06 |