| NPI | 1295253888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT007149) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-09-02 |
| Last Update Date | 2021-05-24 |