| NPI | 1538173927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 0219) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 0219) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-12-08 |