| NPI | 1306269311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 174H00000X Health Educator |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2014-02-03 |