| NPI | 1336250356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 16543) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-09-26 |