| NPI | 1770019796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 77987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 88752) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IN 02006537A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-09-13 |