| NPI | 1194369991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OK 1248) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: FL AL6020) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OK 765) | |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2021-09-13 |