| NPI | 1225784259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA004362) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT002223) |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2022-02-28 |