NPI | 1093708976 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT149) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 2152) |
Enumeration Date | 2005-08-25 |
Last Update Date | 2014-02-24 |