| NPI | 1891236162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: SC 85453) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 566314061) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-07-03 |