| NPI | 1831541184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AK 116052) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096003696) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RTO000174) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-11-02 |