| NPI | 1982672432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 110013) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 14951) |
| 207P00000X Emergency Medicine (Licence: KY 57350) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2023-01-10 |