NPI | 1245849215 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 4690) |
Enumeration Date | 2020-07-27 |
Last Update Date | 2024-08-06 |