| NPI | 1073745659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 265597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 26996) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 26996) | |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2022-09-22 |