NPI | 1043497787 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 000499) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000406) |
Enumeration Date | 2008-01-24 |
Last Update Date | 2017-01-06 |