| NPI | 1033895602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NM AT-2024-0006) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT9424) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2025-06-10 |