| NPI | 1902443518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 090602134) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001749) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00203400) | |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2019-12-02 |