| NPI | 1649243817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0001401) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: IN 36001465A) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2021-08-02 |