| NPI | 1275005399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126003376) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT007235) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 5255) | |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2020-02-25 |