NPI | 1851534085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: GA 069933) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 069933) |
207QS0010X Family Medicine, Sports Medicine (Licence: AL MD31685) | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 156763) | |
Enumeration Date | 2009-04-17 |
Last Update Date | 2021-02-26 |