| NPI | 1851237754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR 10264150) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA ATHL.A1.60944716) |
| Enumeration Date | 2026-04-24 |
| Last Update Date | 2026-04-24 |