| NPI | 1750668141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA A160590112) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36002146A) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.002661) | |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2020-08-13 |