| NPI | 1255749578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ID AT-490) |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist (Licence: FL 637759) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2014-07-30 |