NPI | 1356941710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 051.303261) |
Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302412671) |
Enumeration Date | 2020-10-27 |
Last Update Date | 2024-06-10 |