| NPI | 1013306356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000282) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: DE J3-0000282) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2016-01-04 |