| NPI | 1396294294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083S0010X Preventive Medicine, Sports Medicine (Licence: TX AT8607) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2022-07-14 |