| NPI | 1982138442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301505444) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301505444) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4351045878) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351045878) | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2021-10-27 |