| NPI | 1114985322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AK 124560) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: UT 10650493-4810) |
| 225700000X Massage Therapist (Licence: IL 227005348) | |
| 225700000X Massage Therapist (Licence: AK 117476) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-09-28 |