NPI | 1366964256 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY TCA542) |
Enumeration Date | 2017-07-12 |
Last Update Date | 2025-03-05 |