NPI | 1730597881 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3928) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21527) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 2239) | |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0503) | |
Enumeration Date | 2014-07-31 |
Last Update Date | 2022-02-03 |