| NPI | 1578527859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 5007) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2007-07-08 |