| NPI | 1285179192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL3796) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT.004350) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 1811) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 002903) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT7406) | |
| Enumeration Date | 2017-01-01 |
| Last Update Date | 2020-12-30 |