| NPI | 1598282741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NC 2024-01009) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-103077) |
| 207P00000X Emergency Medicine (Licence: NC 2024-01009) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2024-01009) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL21-0901) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2024-0162) | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2025-08-06 |