NPI | 1013453208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NE 945) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CO AT.0001925) |
Enumeration Date | 2017-01-11 |
Last Update Date | 2019-04-26 |