| NPI | 1356759179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT 0403) |
| Additional Taxonomies | 1744R1102X Specialist, Research Study (Licence: TX AT0403) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2015-03-13 |