| NPI | 1255568309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01255) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2012-01255) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2023-04-19 |