| NPI | 1477956571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR AT-AT-10165211) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 9042194-4810) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2017-04-17 |