| NPI | 1811404171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: LA 337524) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36003343A) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL6250) | |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2024-09-26 |