NPI | 1407172240 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ND 1004-24) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT8540) |
Enumeration Date | 2010-04-19 |
Last Update Date | 2025-02-11 |