| NPI | 1184036337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MA 286638) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO188922) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2021-04-27 |