| NPI | 1255909669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: OK 5607) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 15-02529) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-12 |
| Last Update Date | 2025-08-26 |