| NPI | 1346893070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-5374) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 2401395) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2022-10-06 |