NPI | 1558863449 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA A160585276) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR AT-10174301) |
Enumeration Date | 2018-03-06 |
Last Update Date | 2018-03-06 |