NPI | 1225657505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT7853) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TX AT7853) |
Enumeration Date | 2020-04-15 |
Last Update Date | 2020-04-15 |