| NPI | 1093987034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA08811500) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 279131-01) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME152804) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301094008) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD445960) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2022-02-25 |