| NPI | 1578953899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TN 10988) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001116) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 2128) | |
| 2251S0007X Physical Therapist, Sports (Licence: IN 05012219A) | |
| Enumeration Date | 2015-01-24 |
| Last Update Date | 2016-09-06 |