| NPI | 1386262939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH AT005589) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KY AT1713) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2021-11-09 |