NPI | 1275609778 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CA 070302185) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CA 990994) |
Enumeration Date | 2006-11-27 |
Last Update Date | 2019-10-06 |