| NPI | 1700317013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 35360) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 322664) |
| 207Q00000X Family Medicine (Licence: LA 322664) | |
| 207Q00000X Family Medicine (Licence: OK 35360) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-07-26 |