| NPI | 1912396839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT.003788) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OH 0157021) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2015-01-15 |