| NPI | 1780071811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MI 5101024611) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: MI 5101024611) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2021-10-13 |