| NPI | 1043977309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AZ ATR-100140) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT9025) | |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2024-10-01 |