| NPI | 1972741015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KS 2400645) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT4052) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2009-01-28 |