| NPI | 1457684268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NY 2000001701) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 356641) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2024-01-16 |