NPI | 1932660008 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: PA MT217451) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2019-03-29 |
Last Update Date | 2022-06-22 |