| NPI | 1457026866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 1113) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 115811) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2023-06-05 |