| NPI | 1275140576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 246ZB0301X Specialist/Technologist, Other Biomedical Engineering |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2020-09-30 |