| NPI | 1326434333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301117506) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: MI 4301117506) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2020-10-22 |