| NPI | 1598738007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 685) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2012-01-05 |