| 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 |