| NPI | 1871954560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AL 1257) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 757) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |