| NPI | 1477132363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036169805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.169805) |
| 208000000X Pediatrics (Licence: IL 036.169805) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2025-07-02 |