| NPI | 1619132453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A127744) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A127744) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2021-08-27 |