| NPI | 1528206893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 119483) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MO B-57967) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 530) | |
| Enumeration Date | 2009-01-25 |
| Last Update Date | 2009-01-25 |