| NPI | 1194454868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 10177) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101027619) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151015844) | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-04-23 |