| NPI | 1336527910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36002572A) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2016-05-03 |