| NPI | 1356494140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ 7136A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 0501) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2008-11-25 |