NPI | 1295011872 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT5058) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2013035349) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-01009) | |
Enumeration Date | 2011-10-27 |
Last Update Date | 2016-06-30 |