NPI | 1053862342 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4243) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 865) |
Enumeration Date | 2016-10-20 |
Last Update Date | 2021-07-05 |