| NPI | 1124224407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: IN 05008689A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36001221A) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2007-07-08 |