NPI | 1033966577 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR 2000003675) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR AT-AT-10144482) |
Enumeration Date | 2024-05-02 |
Last Update Date | 2024-05-02 |