NPI | 1629298807 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA rt003485) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25mt00078600) |
Enumeration Date | 2007-04-27 |
Last Update Date | 2007-07-08 |