| NPI | 1992393516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 39612) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 39612) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2023-07-25 |