| NPI | 1972802254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 5535) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 05-51964) |
| 207Q00000X Family Medicine (Licence: OK 5535) | |
| 207Q00000X Family Medicine (Licence: TX W1394) | |
| 207Q00000X Family Medicine (Licence: AR E-13441) | |
| 207P00000X Emergency Medicine (Licence: MO 2011020294) | |
| 207P00000X Emergency Medicine (Licence: AR E-13441) | |
| 207Q00000X Family Medicine (Licence: MO 2025044563) | |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2025-10-28 |