NPI | 1033895602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NM AT-2024-0006) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT9424) |
Enumeration Date | 2023-06-27 |
Last Update Date | 2025-06-10 |