NPI | 1053786723 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NH 0650) |
Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NH 32679 E) |
Enumeration Date | 2015-12-07 |
Last Update Date | 2015-12-07 |