NPI | 1194252122 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 11749284-4810) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000027394) |
Enumeration Date | 2017-05-22 |
Last Update Date | 2021-07-21 |