NPI | 1497840649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN AT437) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT391) |
Enumeration Date | 2006-10-04 |
Last Update Date | 2007-07-08 |