| NPI | 1295291060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 225500000X Specialist/Technologist (Licence: AL 2588) |
| Enumeration Date | 2019-02-15 |
| Last Update Date | 2022-01-04 |