| NPI | 1932733771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT BOC373277) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2024-01-12 |