NPI | 1366760555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001077a) |
Additional Taxonomies | 174400000X Specialist (Licence: IN 36001077A) |
Enumeration Date | 2010-05-12 |
Last Update Date | 2010-05-13 |