| NPI | 1588252324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 559) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: SC 559) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2021-01-07 |