| NPI | 1346686599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DC AT23000024) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 67 002138) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126004015) | |
| 225700000X Massage Therapist (Licence: VA 0019019674) | |
| 225700000X Massage Therapist (Licence: DC MT200001343) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2024-10-15 |