| NPI | 1538607635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2016032815) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: MO 2016032815) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2020-09-04 |