NPI | 1619467610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 38243) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 38243) |
207Q00000X Family Medicine (Licence: ID MRM-1732) | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 38243) | |
Enumeration Date | 2018-05-15 |
Last Update Date | 2022-05-31 |