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 |