NPI | 1871517334 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MO MO 01472) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO MO 108986) |
Enumeration Date | 2006-07-27 |
Last Update Date | 2007-07-08 |