| NPI | 1306834056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: RI AT00214) |
| Additional Taxonomies | 2255R0406X Specialist/Technologist Rehabilitation, Blind (Licence: RI AT00214) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2007-07-08 |