| NPI | 1104853076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IA 001494) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 118165) |
| 225200000X Physical Therapy Assistant (Licence: KS 14-01954) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 000871) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2010-11-07 |