| NPI | 1245290691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: UT 3105605-4701) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2007-07-08 |