| NPI | 1861755035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036.137275) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT202002) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2015-09-01 |