| NPI | 1508278466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A160385) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 54573) |
| 207Q00000X Family Medicine (Licence: AZ R74419) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD209993) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2020-0475) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2023-09-13 |