| NPI | 1770037822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME143365) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: GA 83402) |
| 207RS0010X Internal Medicine Sports Medicine (Licence: GA 83402) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2020-10-06 |