| NPI | 1972147635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000040993) |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2026-01-22 |