NPI | 1497122881 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001718) |
Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MI 3203056420) |
Enumeration Date | 2015-09-01 |
Last Update Date | 2017-01-09 |