| NPI | 1043609282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 2733) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 000900) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-2457) | |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2021-08-11 |