NPI | 1528292182 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0415) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME at352) |
Enumeration Date | 2009-05-12 |
Last Update Date | 2009-05-12 |