NPI | 1508948860 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001192) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00123000) |
Enumeration Date | 2006-10-19 |
Last Update Date | 2024-03-21 |