| NPI | 1164166179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 8374) |
| 207Q00000X Family Medicine (Licence: AR E-17336) | |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2024-05-23 |