| NPI | 1699231860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT8416) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX 767526) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 146N00000X Emergency Medical Technician, Basic (Licence: CT 70.026591) | |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2023-12-12 |