| NPI | 1740768399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027079) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 178410) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005839) | |
| Enumeration Date | 2018-08-04 |
| Last Update Date | 2018-08-04 |