| NPI | 1811927254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT001549A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO 767) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 96-039) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000152A) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 000153-1) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2017-08-13 |