NPI | 1790757060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL pta1272) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL al411) |
Enumeration Date | 2006-02-02 |
Last Update Date | 2007-07-08 |