| NPI | 1083158331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NY 013970) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2025-06-21 |