| NPI | 1710539978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT030917) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT007335) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2023-02-22 |