| NPI | 1134578347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: IA 000918) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: WI 1926-39) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-08-02 |