| NPI | 1023272689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096002623) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: IL 060024957) |
| 246Z00000X Specialist/Technologist, Other | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2018-03-17 |