NPI | 1700079837 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: IN 05001844A) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000225A) |
Enumeration Date | 2007-08-22 |
Last Update Date | 2007-08-22 |