Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | OS015906 | PA |
NPI | 1174844310 |
---|---|
Provider Name | Christopher Rial |
First Address | Erie, PA 16505-2571 |
Second Address | Erie, PA 16509-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 05/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1029038360001 | (05) | PA |