| NPI | 1538451588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A125822) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GU MD1823) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX bp10056188) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2023-09-20 |