| NPI | 1265186589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 3285) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 1437) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT477) | |
| Enumeration Date | 2022-02-06 |
| Last Update Date | 2025-12-14 |