| NPI | 1063957280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003900-01) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003900) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-12-24 |
| Last Update Date | 2020-03-23 |