NPI | 1801586169 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-008926) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ ATR-000531) |
Enumeration Date | 2023-05-10 |
Last Update Date | 2023-05-10 |