| NPI | 1316580491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ME PA5638) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT749) |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2020-06-26 |