| NPI | 1528615069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031353) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014724) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT007337) | |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2023-07-14 |