| NPI | 1669872420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NV 0506408) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 0) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 0) | |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2021-12-01 |