| NPI | 1366576670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096002191) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL2023) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT3267) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT001604) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: LA ATH.200358) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2018-12-19 |