| NPI | 1821341447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT4598) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX 168141) |
| 146N00000X Emergency Medical Technician, Basic (Licence: AR 22756) | |
| 174H00000X Health Educator (Licence: TX 1634643) | |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2012-10-19 |