| NPI | 1407648835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT004863) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 6211) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ ATR-001708) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 2518) | |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2025-05-21 |