NPI | 1386345056 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2023-03-10 |
Last Update Date | 2023-03-10 |