| NPI | 1487195350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NC P16742) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-3053) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-03-13 |