NPI | 1174596514 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 386) |
Additional Taxonomies | 174400000X Specialist (Licence: TX AT2846) |
Enumeration Date | 2006-02-08 |
Last Update Date | 2015-04-17 |