| NPI | 1881071041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: LA 323284) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 10077814-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2023-08-15 |