NPI | 1386187789 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: RI AT00458) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MA 3020) |
Enumeration Date | 2016-12-02 |
Last Update Date | 2024-04-10 |