| NPI | 1023486198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ND 694-15) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MN 2674) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2020-03-23 |