| NPI | 1376516336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AZ 20) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IA 179) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: SD 116) | |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ID AT-186) | |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IL 096-002084) | |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TN 918) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2021-01-19 |