| NPI | 1376048223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 43796) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: NM MD2021-0835) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2025-02-19 |