| NPI | 1194252122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 11749284-4810) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000027394) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2021-07-21 |