| NPI | 1215998182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME 070502046) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: ME MT3902) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2008-10-20 |