| NPI | 1669825378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2019003140) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT003035) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL3344) | |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2019-02-04 |