| NPI | 1700226669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A141844) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A141844) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.063987) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2022-07-06 |