| NPI | 1861486086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 0649) |
| Additional Taxonomies | 2255R0406X Specialist/Technologist, Rehabilitation, Blind (Licence: NC 0649) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2014-08-20 |