NPI | 1679029177 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 13929) |
Additional Taxonomies | 225100000X Physical Therapist |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 2000028823) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-08-25 |
Last Update Date | 2023-07-18 |