| NPI | 1447467527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MA 1463) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 16036) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2025-09-11 |