| NPI | 1295275493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306605790) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: VA 0126002673) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2021-09-13 |