| NPI | 1215270681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: VA 0126002682) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: VT 104.0087653) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NH 0597) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2022-03-29 |