| NPI | 1346841749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 2643) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: 0155-0083-2810) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2023-12-04 |