| NPI | 1710340310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AZ 1517) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA RT005978) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-12-24 |