| NPI | 1851953798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA 60791435) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00215400) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT6913) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003516-1) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT006357) | |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2019-07-01 |