| NPI | 1467446864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MA PT-4773) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CA PT-9267) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA AT-278) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2007-07-08 |