| NPI | 1730527706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 174H00000X Health Educator (Licence: IN 10067876) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2013-06-11 |