NPI | 1043609282 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TN 2733) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CT 000900) |
2255A2300X Specialist/Technologist Athletic Trainer (Licence: NC LAT-2457) | |
Enumeration Date | 2015-01-12 |
Last Update Date | 2021-08-11 |