| NPI | 1578822730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NJ 25MA10209400) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: NJ 25MA10209400) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: PA MT201720) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2021-11-26 |