| NPI | 1154636561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P2788) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27031) |
| 207Q00000X Family Medicine (Licence: TX P2788) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX P2788) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10034162) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 27031) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2020-09-10 |