| NPI | 1164832903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 42486) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: MO 2023000705) | |
| 207P00000X Emergency Medicine (Licence: LA 306789) | |
| 207Q00000X Family Medicine (Licence: MO 2023000705) | |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2025-01-16 |