| NPI | 1639574288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024958) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209845) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NY 002610) | |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: PA RT005795) | |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2016-02-08 |