NPI | 1154536936 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN 2525) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TN 89) |
Enumeration Date | 2007-05-14 |
Last Update Date | 2007-07-08 |