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 |