NPI | 1336617323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT003569) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR AT767) |
Enumeration Date | 2018-11-07 |
Last Update Date | 2020-04-22 |