NPI | 1043674971 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: PA MD470144) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2016-04-06 |
Last Update Date | 2020-08-17 |