| NPI | 1013434349 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 2000020757) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 084252) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2017-08-28 |