| NPI | 1396386306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000040994) | |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2026-02-05 |