| NPI | 1083241228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301505818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1015023) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301505818) | |
| 208D00000X General Practice (Licence: OH 35.143499) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-07-28 |