| NPI | 1538766191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT6938) |
| Additional Taxonomies | 226300000X Kinesiotherapist (Licence: TX AT6938) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2020-10-07 |