NPI | 1396366332 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 89521) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 89521) |
Enumeration Date | 2020-04-30 |
Last Update Date | 2023-06-23 |