| NPI | 1518460948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E115899) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2020-02-13 |