NPI | 1275946998 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 000728) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36002200A) |
Enumeration Date | 2014-06-10 |
Last Update Date | 2018-03-17 |