NPI | 1306581434 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-01018) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 05-35604) |
Enumeration Date | 2022-05-03 |
Last Update Date | 2022-05-03 |