NPI | 1386163855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36604) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 2000015008) |
Enumeration Date | 2017-09-15 |
Last Update Date | 2022-03-17 |