NPI | 1093277659 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000034460) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT006015) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ZZ 2-5536) | |
Enumeration Date | 2019-04-03 |
Last Update Date | 2019-10-23 |