| NPI | 1205856994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1744R1102X Specialist, Research Study |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT1195) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |