| NPI | 1962841155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL DO.2905) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS018106) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2022-09-06 |