| NPI | 1164189080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-5681) |
| Enumeration Date | 2021-11-27 |
| Last Update Date | 2024-05-06 |