| NPI | 1295232338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A176672) |
| Additional Taxonomies | 207PS0010X Emergency Medicine Sports Medicine (Licence: CA 176672) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA 176672) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2022-07-27 |