| NPI | 1659837227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT9261) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NM AT-2025-0013) |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2025-11-19 |