| NPI | 1669509204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00137700) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 2065) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001452-1) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT006961) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2019-05-11 |