| NPI | 1386981504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: UT 8021359-4810) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other Orthopedic Assistant |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2019-07-28 |