NPI | 1154545887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 070502170) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 843) |
Enumeration Date | 2007-04-12 |
Last Update Date | 2008-09-15 |