NPI | 1720018849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10001569) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J30000038) |
Enumeration Date | 2006-07-04 |
Last Update Date | 2008-01-15 |