| NPI | 1265580476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID E KOCH Owner 262-620-1650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WI 270-039) |
| Enumeration Date | 2007-01-07 |
| Last Update Date | 2020-08-22 |