| NPI | 1326692435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA A161319246) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ ATR-009208) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 11377153-4810) | |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2022-07-25 |