| NPI | 1740714997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126003602) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 939) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 009087) | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2023-06-12 |