NPI | 1336186717 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH2028) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 96096) |
Enumeration Date | 2006-06-02 |
Last Update Date | 2007-07-08 |