| NPI | 1639668965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: KY 05349) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 05349) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: IN 02006869A) | |
| 207R00000X Internal Medicine (Licence: IN 02006869A) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: KY 05349) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2026-02-09 |