| NPI | 1528559960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: VA 1010270208) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101270208) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116031297) | |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2023-08-02 |