| 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 |