| NPI | 1538430368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH 005026) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 566) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126001224) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2019-02-05 |