| NPI | 1710025085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CO PTL.0007135) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 0696) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0001799) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2022-04-13 |