| NPI | 1275949125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A00414) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000463) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005276) | |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2014-07-10 |