| NPI | 1699269670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: MA 291842) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A164985) |
| 207R00000X Internal Medicine (Licence: MA 291842) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2023-06-21 |