| NPI | 1023628575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: HI AT-447-0) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NV 0506214) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2025-07-16 |