| NPI | 1134183882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 080102097) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001275-1) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO 560) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2012-10-17 |