| NPI | 1376748624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 334115) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01067579A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2025-07-16 |