NPI | 1912961053 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000741A) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06001886A) |
Enumeration Date | 2006-04-14 |
Last Update Date | 2018-03-17 |