| NPI | 1851363410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: OK PT1273) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK AT29) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2007-07-08 |