| NPI | 1588044416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 002846-01) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 1506) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00194400) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2025-11-13 |