| NPI | 1548489511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001072-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0222471) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2025-09-11 |