| NPI | 1548438500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH PTA.07472) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06003631A) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001444A) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT.003322) | |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2011-12-08 |