| NPI | 1134573025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 1288) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL4553) |
| 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1628) | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2022-07-21 |