| NPI | 1063409332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36001023A) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: IN 36001023A) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2018-06-16 |