| NPI | 1588530489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2025-10-16 |
| Last Update Date | 2025-10-16 |