| NPI | 1023438041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD465170) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD465170) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD465170) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2023-01-23 |