| NPI | 1346695533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY TCA099) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2019020157) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 3295) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096004399) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2024-11-06 |