| NPI | 1114426319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT9206) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY TCA972) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT1931) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 1163) | |
| Enumeration Date | 2018-02-03 |
| Last Update Date | 2024-01-28 |