NPI | 1326692435 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL7393) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 11377153-4810) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ ATR-009208) | |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA A161319246) | |
Enumeration Date | 2019-07-26 |
Last Update Date | 2025-05-19 |