NPI | 1750778742 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 508) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OK 1602) |
Enumeration Date | 2015-04-17 |
Last Update Date | 2015-04-17 |