| NPI | 1548753262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1401-ah-at) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA ah-1401-at) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2018-06-07 |