NPI | 1386182293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018854) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0002162) |
Enumeration Date | 2017-02-11 |
Last Update Date | 2022-12-27 |