NPI | 1447604293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CT 066416) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 066416) |
390200000X Student in an Organized Health Care Education/Training Program | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-04-18 |
Last Update Date | 2023-01-17 |