NPI | 1134183882 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 080102097) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001275-1) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO 560) | |
Enumeration Date | 2006-04-12 |
Last Update Date | 2012-10-17 |