| NPI | 1679989149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1874) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: FL EMT 539865) |
| Enumeration Date | 2014-07-06 |
| Last Update Date | 2016-07-29 |