| NPI | 1700343746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: CO AT.0001666) |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2019-02-26 |