| NPI | 1386484582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0396) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA ATL3290) |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2024-05-28 |