| NPI | 1518954338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 0000000052) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: TN 5628) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2014-02-10 |