NPI | 1093177271 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18366) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A18366) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-03-25 |
Last Update Date | 2021-03-22 |