NPI | 1083292130 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD484891) |
Enumeration Date | 2021-03-31 |
Last Update Date | 2024-07-11 |