| NPI | 1144293408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: FL PT 20698) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 1654) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2014-01-20 |