| NPI | 1861070336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A197571) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: CA A197571) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-05-23 |