| NPI | 1871029561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA AT002757) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2021-01-29 |