| NPI | 1164186342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 2990) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005954) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00207500) | |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2021-10-25 |