| NPI | 1023032513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ID PTA-2416) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225200000X Physical Therapy Assistant (Licence: WA P160049952) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2014-08-27 |