NPI | 1063173920 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: SC SC509800) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: GA AT003807) |
Enumeration Date | 2022-01-04 |
Last Update Date | 2022-01-04 |