| NPI | 1720658628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OK 39593) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 39593) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 39593) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2023-08-23 |