| NPI | 1316231616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WI 1830-19) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1435-39) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2016-06-22 |