| NPI | 1386952273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: TN 10483) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TN 1386) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2019-09-16 |