| NPI | 1598295792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT006658) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: PA RT006658) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2017-06-20 |