| NPI | 1386044162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-3859) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: LA 303357) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2021-05-19 |