| NPI | 1215492566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 225500000X Specialist/Technologist |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2019-01-31 |