NPI | 1548323090 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ME AT139) |
Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: ME 20114) |
Enumeration Date | 2006-12-18 |
Last Update Date | 2014-06-15 |