| NPI | 1972183028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL7453) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT004341) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT2178) | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2025-06-17 |