| NPI | 1932477510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005800) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: PA PT023551) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2014-10-25 |