NPI | 1205301124 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: FL 5743) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KS 24-01215) |
Enumeration Date | 2018-10-07 |
Last Update Date | 2019-10-07 |