| NPI | 1497208656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT1480) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2062368) |
| Enumeration Date | 2016-07-24 |
| Last Update Date | 2020-01-07 |