| NPI | 1346695533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT2259) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 3295) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2019020157) | |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2025-10-08 |