| NPI | 1922200088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI MAT-4202) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2008-08-25 |