| NPI | 1467441626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 2462) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: SC 2462) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: SC 2462) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 2462) | |
| 225400000X Rehabilitation Practitioner (Licence: SC 2462) | |
| 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: SC 2462) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2021-12-29 |