NPI | 1326683988 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2863) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 009274) |
Enumeration Date | 2019-11-07 |
Last Update Date | 2023-12-03 |