NPI | 1457761405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.003575) |
Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: IL 060495082) |
Enumeration Date | 2014-04-30 |
Last Update Date | 2014-04-30 |