Individual
CRAIG COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4190 CITY AVE, PHILADELPHIA, PA 19131-1626
(918) 933-7032
Mailing address
4190 CITY AVE, PHILADELPHIA, PA 19131-1626
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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