| NPI | 1689601247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TE1100X Psychologist, Exercise & Sports |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2025-04-07 |