| NPI | 1306116728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0576) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: MA 02233) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2016-04-26 |