| NPI | 1538639117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: FL AL4120) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH AT003951) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MD A0000734) | |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-11-27 |