| NPI | 1609839224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0171) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT408) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2007-07-08 |