| NPI | 1982159216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126003148) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1796) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2849) | |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2021-08-12 |