| NPI | 1609272137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH 0037475298) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: OH 179383) |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2025-10-06 |