| NPI | 1427745736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT022593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT022593) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA OT022593) | |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2026-08-31 |