| NPI | 1659769388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024227) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000437) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT006059) | |
| 225100000X Physical Therapist (Licence: WV PT003438) | |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-02-10 |