| NPI | 1588010540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: SC 2000027634) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: SC BOC335022) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2020-12-31 |