NPI | 1053680215 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2008018812) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2004014100) |
Enumeration Date | 2011-12-17 |
Last Update Date | 2011-12-17 |