NPI | 1164652582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3386) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0416) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1524) | |
Enumeration Date | 2009-07-20 |
Last Update Date | 2009-07-20 |