| NPI | 1225382393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ME PA5621) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT436) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2020-06-03 |