| NPI | 1871130625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT01286L) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT000964A) |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2019-11-27 |