| NPI | 1558525030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: PA MT193869) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193869) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MT193869) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2020-08-13 |