NPI | 1033655477 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 2527-39) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: HI AT-344) |
Enumeration Date | 2017-01-09 |
Last Update Date | 2023-02-09 |