| NPI | 1235536012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHEVON MALTBIA Athletic Trainer 773-676-7692 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096002737) |
| Enumeration Date | 2014-11-22 |
| Last Update Date | 2014-11-22 |