| NPI | 1811061401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CT 000996) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CT 000022) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 000390) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2008-04-12 |