| NPI | 1114326238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2535) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MN 1025448) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2023-12-26 |