| NPI | 1457776700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005434) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 147949) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |