| NPI | 1932155199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 1192) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT003187) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL-1589) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2025-01-10 |