| NPI | 1356695944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 1602) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: NY 002612) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 3159) | |
| Enumeration Date | 2012-11-03 |
| Last Update Date | 2023-02-16 |