NPI | 1023155520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11424-24) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 868039) |
Enumeration Date | 2007-01-31 |
Last Update Date | 2014-08-27 |