NPI | 1194105353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 31629) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
207P00000X Emergency Medicine (Licence: OK 31629) | |
Enumeration Date | 2015-06-03 |
Last Update Date | 2018-09-20 |