| NPI | 1558670182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 2077) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: RI AT00480) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2021-08-02 |