| NPI | 1164931960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003657-1) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2023-06-11 |