| NPI | 1235261462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ND 854) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ND 188-98) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-08 |