| NPI | 1477505311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA AT 8010) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 110102194) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2013-08-01 |