NPI | 1184901050 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0468) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1908) |
Enumeration Date | 2011-11-07 |
Last Update Date | 2011-11-07 |