| NPI | 1134598949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000014095) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2024-12-24 |