| NPI | 1407239734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TN 2491) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH AT005508) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2017022932) | |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2019-09-16 |