NPI | 1760841423 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: TN 70735) |
Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 30650) |
208D00000X General Practice (Licence: NE 30650) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-02-23 |
Last Update Date | 2024-06-17 |