| NPI | 1699346411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AR PTA4657) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 2021037957) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2021024436) | |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2023-12-22 |