| NPI | 1942736970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-3599) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR AT 535) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-00907) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-10-06 |