NPI | 1972610772 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 119-039) |
Enumeration Date | 2006-08-25 |
Last Update Date | 2024-08-01 |