| NPI | 1740086891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 11457852-4810) |
| Enumeration Date | 2025-02-20 |
| Last Update Date | 2025-02-20 |