| NPI | 1538398805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A4433) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT.002684) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0000795) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2016-08-23 |