| NPI | 1003437468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 35764) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 35764) |
| 208000000X Pediatrics (Licence: OK 35764) | |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2021-12-11 |