| NPI | 1598271629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126001962) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL3767) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 1580) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT002903) | |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2020-11-06 |