| NPI | 1912305418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MS AT0702) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2020-08-25 |