| NPI | 1174826325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NE 119702410) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AT7784) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2022-06-03 |