| NPI | 1730647181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: PA PT03651) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000581) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RTO000373) | |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2024-08-11 |