| NPI | 1457798217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: DC MD045407) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD045407) |
| 207Q00000X Family Medicine (Licence: VA 0101260073) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: OR MD212941) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 256285) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2023-04-21 |