| NPI | 1285238337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 538) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 9439) |
| Enumeration Date | 2020-11-29 |
| Last Update Date | 2020-11-29 |