| NPI | 1326331067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: MO 123380) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2001008723) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096002847) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2011-06-09 |