| NPI | 1639372709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT001169) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: GA 02 5855) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ID AT-391) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2011-06-09 |