NPI | 1184987059 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT-198) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT-166) |
Enumeration Date | 2012-06-16 |
Last Update Date | 2012-06-16 |