| NPI | 1316576275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: PA OT020279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS022459) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2023-06-25 |