| NPI | 1619934478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 5405724-4810) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2008-02-19 |