| NPI | 1558722009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT004159) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: VA B202103473) |
| 146N00000X Emergency Medical Technician, Basic (Licence: CO Q161562) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0001869) | |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2022-08-03 |