| NPI | 1457622169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601000422) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT1032) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL.2968) | |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2016-07-18 |