| NPI | 1205240835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 290946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 290946) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2023-06-30 |