| NPI | 1366971301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2017022236) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT10609) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 2037) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR AT-AT-10273463) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126004525) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-01277) | |
| Enumeration Date | 2017-06-04 |
| Last Update Date | 2026-07-27 |