| NPI | 1972183028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT004341) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: GA E036690) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2023-08-06 |