| NPI | 1679536635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KS 24-00041) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: KS 041037) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2015-02-18 |