| NPI | 1497764658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VT 104.0000165) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: NH 09-0203) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0363) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2011-07-06 |