| NPI | 1780139345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH AT. 004994) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NY 003154) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2016-08-23 |