| NPI | 1629232152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0048362) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003816A) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IN 02003816A) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL2906) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2019-02-04 |