NPI | 1154535078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL pt22266) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: FL pt22266) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL al2121) | |
Enumeration Date | 2007-05-09 |
Last Update Date | 2007-07-08 |