NPI | 1497266993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63710) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR 2000038059) |
Enumeration Date | 2017-10-24 |
Last Update Date | 2023-01-11 |