NPI | 1346560455 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A118684) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 268986) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2010-06-11 |
Last Update Date | 2021-08-26 |