NPI | 1982165502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0001627) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28990) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT007587) | |
Enumeration Date | 2019-03-27 |
Last Update Date | 2025-03-10 |