NPI | 1164782041 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MS 5264) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MS AT0461) |
Enumeration Date | 2012-05-24 |
Last Update Date | 2014-07-21 |