NPI | 1154726081 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 13772) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN AT1476) |
Enumeration Date | 2014-11-04 |
Last Update Date | 2024-03-22 |