NPI | 1508227984 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003972) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1522) |
Enumeration Date | 2016-03-14 |
Last Update Date | 2020-12-05 |