| NPI | 1992773972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 174400000X Specialist (Licence: IN 36000424A) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2016-03-14 |