| NPI | 1689262644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-5302) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT8466) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT8522) | |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2025-10-06 |