NPI | 1679536635 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-00041) |
Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: KS 041037) |
Enumeration Date | 2006-04-10 |
Last Update Date | 2015-02-18 |