| NPI | 1316497621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MN 3468) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ND 767-17) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2024-01-23 |