| NPI | 1306097332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS013699) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT011023) |
| 207Q00000X Family Medicine (Licence: PA OS013699) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB09249700) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 311153) | |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2022-02-21 |