| NPI | 1053786616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NY 004535) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT5928) | |
| 246RP1900X Technician, Pathology Phlebotomy | |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2023-02-03 |