NPI | 1285024752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT 003444) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: DE J3-0000423) |
Enumeration Date | 2015-02-04 |
Last Update Date | 2015-02-04 |