NPI | 1356693634 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA P1 60167096) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA A1 60030239) |
Enumeration Date | 2012-10-10 |
Last Update Date | 2012-10-10 |