NPI | 1427158260 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 2364) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT000508) |
Enumeration Date | 2006-09-22 |
Last Update Date | 2019-05-27 |