| NPI | 1437443330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD047655) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME116667) |
| 207R00000X Internal Medicine (Licence: VA 0101256150) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: VA 0101256150) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2022-11-07 |