| NPI | 1134689151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000020198) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000735) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0000748) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2019-03-25 |