| NPI | 1417304346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S04166) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2025-02-11 |