| NPI | 1114447984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 6370) |
| Additional Taxonomies | 261QS1000X Clinic/Center Student Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2020-06-05 |