| NPI | 1710686365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH AT3272) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KY AT1144) |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2023-03-02 |