| NPI | 1639666951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR AT881) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2022-02-08 |