| NPI | 1851498802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2087190) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT1538) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-05-01 |