NPI | 1659760189 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30000) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL PT30000) |
Enumeration Date | 2015-01-21 |
Last Update Date | 2015-02-06 |