| NPI | 1811575012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AR E-18978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301511513) |
| 207Q00000X Family Medicine (Licence: AR E-18978) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-06-11 |