| NPI | 1558013201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ND 975-23) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NV 0506567) |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2024-01-15 |