| NPI | 1528024361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN AT0000000102) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: TN EMT0000019804) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2016-03-11 |