| NPI | 1629131123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR MORAN CEO 765-284-7738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000201A) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-11-29 |