| NPI | 1427444686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 293617) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 293617) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: MO 2019024776) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 293617) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2022-03-17 |