| NPI | 1093052664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 34822) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2223) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2022-07-12 |