NPI | 1265582803 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1226) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR AT224) |
Enumeration Date | 2007-01-12 |
Last Update Date | 2020-08-11 |