NPI | 1053709659 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT1203) |
Enumeration Date | 2015-01-05 |
Last Update Date | 2021-05-20 |