| NPI | 1093135857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028379) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01984100) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RTO000184) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00192700) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2021-11-09 |