| NPI | 1497295695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: 2000032326) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: PA RT007505) | |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2021-01-18 |