| NPI | 1295002699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AR PT3520) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AR AT 436) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2013-10-04 |