NPI | 1639574288 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024958) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209845) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 002610) | |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005795) | |
Enumeration Date | 2014-10-24 |
Last Update Date | 2016-02-08 |