NPI | 1013306356 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000282) |
Additional Taxonomies | 174H00000X Health Educator (Licence: DE J3-0000282) |
Enumeration Date | 2015-01-09 |
Last Update Date | 2016-01-04 |