| NPI | 1093277659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000034460) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT006015) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ZZ 2-5536) | |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2019-10-23 |