NPI | 1275753931 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT003847) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00123900) |
Enumeration Date | 2007-04-26 |
Last Update Date | 2014-05-08 |