| NPI | 1851783716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000021255) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E098290) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-07-23 |