| NPI | 1144473406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000501A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06003172) |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2024-07-02 |