| NPI | 1184710923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A3598) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 1201) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-04-13 |