| NPI | 1629504741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 306210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 306210) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2023-03-21 |