| NPI | 1306834056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255R0406X Specialist/Technologist, Rehabilitation, Blind (Licence: RI AT00214) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: RI AT00214) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2025-09-11 |