| NPI | 1861750507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CA 20A14459) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: NY 271358) | |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2022-08-05 |