| NPI | 1992266910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 96458) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 82306) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: SC 82306) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2023-09-08 |