| NPI | 1225781842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT033675) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA 32207874) |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2025-08-21 |