| NPI | 1588001754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036144480) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301103062) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301103062) | |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2021-11-18 |