| NPI | 1679024863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL5928) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 93753) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-22 |
| Last Update Date | 2024-01-24 |