NPI | 1265851646 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: MS 28825) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2014-04-14 |
Last Update Date | 2021-06-07 |