NPI | 1184744716 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212445) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872413) |
225100000X Physical Therapist (Licence: TX 1173220) | |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT2595) | |
Enumeration Date | 2007-03-29 |
Last Update Date | 2020-05-19 |