| NPI | 1497383988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: MO 2024037153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 83232) |
| 208D00000X General Practice (Licence: SC 83232) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-08-27 |