| NPI | 1497871800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MT 48ATR) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MT 185735) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2011-09-21 |