NPI | 1659671980 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ND 953-22) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001062) |
Enumeration Date | 2010-11-03 |
Last Update Date | 2023-08-15 |