| NPI | 1285860015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN 6018) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 069502664) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 540) | |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2015-06-12 |