NPI | 1407250210 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A00653) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 2126) |
Enumeration Date | 2014-10-22 |
Last Update Date | 2014-10-22 |