| NPI | 1386013092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028944) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT006317) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2024-06-26 |