| NPI | 1427636034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102208567) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.017747) | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2025-09-29 |