| NPI | 1417954637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000633A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008318A) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2014-09-18 |