NPI | 1013142884 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2018003451) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2015028965) | |
Enumeration Date | 2009-05-22 |
Last Update Date | 2018-02-08 |