| NPI | 1366760555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36001077A) |
| Additional Taxonomies | 174400000X Specialist (Licence: IN 36001077A) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2010-05-13 |