| NPI | 1851889158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101275769) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D0094921) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD473773) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2022-10-21 |