NPI | 1750024162 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 2414) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
2255A2300X Specialist/Technologist, Athletic Trainer | |
Enumeration Date | 2022-04-14 |
Last Update Date | 2022-08-04 |