| NPI | 1548209786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT007502L) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT003229) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2008-01-16 |