| NPI | 1881147502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000029569) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E116639) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2022-12-29 |