| NPI | 1023504032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 14225062-4810) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2026-04-09 |