| NPI | 1548983430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 246RP1900X Technician, Pathology Phlebotomy |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2024-06-10 |