| NPI | 1043384985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: WI 1790-024) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MN 1543) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 23-039) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |