| NPI | 1366470031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ID PTA-2676) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ID AT094) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2011-07-07 |