| NPI | 1306437579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-01516) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: KS 24-01516) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-04-23 |