NPI | 1821431859 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 81755) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 81755) |
207Q00000X Family Medicine (Licence: FL OS12908) | |
390200000X Student in an Organized Health Care Education/Training Program | |
207QS0010X Family Medicine, Sports Medicine (Licence: FL OS12908) | |
Enumeration Date | 2013-04-09 |
Last Update Date | 2025-01-29 |