| NPI | 1235713223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.150573) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2024-05-27 |