| NPI | 1265841613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT5408) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36002364A) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 3851) | |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2015-12-04 |