| NPI | 1013315761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005694) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0598) |
| 146N00000X Emergency Medical Technician, Basic (Licence: PA 186907) | |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2014-12-11 |