| NPI | 1730241399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: UT 037407) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 94-273535-2401) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 273535-4810) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |