| NPI | 1225589260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT2216) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 94273) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 020102108) | |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2016-10-14 |