| NPI | 1548679160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT1974) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: KY AT1974) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2023-09-28 |