| NPI | 1033774633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: SC 82649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 94991) |
| 207QS0010X Family Medicine Sports Medicine (Licence: GA 94991) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2023-09-18 |