NPI | 1043758386 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0001197) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36002878A) | |
Enumeration Date | 2017-02-07 |
Last Update Date | 2020-05-08 |