NPI | 1609268473 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MN 2750) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WI 1541) |
Enumeration Date | 2015-03-03 |
Last Update Date | 2016-05-10 |