| NPI | 1609146968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CT 000972) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CT 000190) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |