| NPI | 1326374562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 8743560-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101018542) |
| 207Q00000X Family Medicine (Licence: AR E7679) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101018542) | |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2020-02-18 |