| NPI | 1902343163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT004020) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OH 0155886) |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2017-01-26 |