| NPI | 1679048664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 8127752-4810) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 81277524810) |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2018-10-05 |