| NPI | 1780027417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: RI MD17195) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: OH 35.127042) | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2020-07-31 |