| NPI | 1295271211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 097122) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 3015) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SD 0639) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2017-01-14 |
| Last Update Date | 2020-07-27 |