| NPI | 1881681708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OK TA678) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 286) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2007-07-08 |