| NPI | 1649353756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL 27670) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: AL 27670) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 23502) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2023-01-09 |