| NPI | 1578536447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ ATR-009261) |
| Additional Taxonomies | 1744R1102X Specialist, Research Study |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2022-10-31 |