| NPI | 1659349108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2058259) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 2000172010) |
| 225200000X Physical Therapy Assistant (Licence: IL 160003678) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2001007778) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2007-07-31 |