| NPI | 1386095412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36003136A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT6680) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CO AT.0001813) | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2020-01-19 |