| NPI | 1598161218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: HI 83) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI 10008) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2014-11-06 |