| NPI | 1639603434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT006584) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA E3202115) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2017-04-18 |