| NPI | 1881849909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT016099) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC PT-11753) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC AT-1530) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT003279) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2025-06-05 |