| NPI | 1215302724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA 61543452) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT8128) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2025-10-06 |