| NPI | 1730452798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MT 2454) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MT 22) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2012-02-21 |