| NPI | 1295011872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT5058) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2013035349) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KS 24-01009) | |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2016-06-30 |