| NPI | 1205592409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NM AT-2024-0002) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT9926) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2025-11-24 |