| NPI | 1447659271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126002142) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1033-39) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT.001873) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2018-01-17 |