| NPI | 1811460082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031441) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00302200) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT007664) | |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2023-08-04 |