NPI | 1508900465 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 079102593-0234) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 2146) |
Enumeration Date | 2007-02-16 |
Last Update Date | 2025-09-11 |