NPI | 1790340693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2018016971) |
Enumeration Date | 2019-05-06 |
Last Update Date | 2025-08-14 |