| NPI | 1780189167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36002867A) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: IN 5912-6847) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2023-12-05 |