| NPI | 1548323090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT139) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: ME 20114) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2014-06-15 |