| NPI | 1306017629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A4063) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001833-1) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0000592) | |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2014-02-03 |