| NPI | 1891985438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR AT120) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2007-07-30 |