| NPI | 1700295755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CT 1227) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ID AT-431) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2020-03-02 |