| 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 |