| NPI | 1194798363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT6688) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 2036) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001111A) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2024-02-07 |