| NPI | 1043873706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 7054) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 0335R) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2020-10-24 |