NPI | 1114303401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225500000X Specialist/Technologist (Licence: MD 18753MD) |
Additional Taxonomies | 171W00000X Contractor (Licence: MD 18753MD) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD 18753MD) | |
Enumeration Date | 2015-08-10 |
Last Update Date | 2015-08-10 |