| NPI | 1174766620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NV 15428) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NV 15428) |
| 2081P0004X Physical Medicine & Rehabilitation Spinal Cord Injury Medicine (Licence: NV 15428) | |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NV 15428) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV 15428) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2024-08-13 |