| NPI | 1972046308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0001708) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-12-03 |
| Last Update Date | 2017-08-21 |