NPI | 1699743948 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 0564) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096-002083) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ID AT-266) | |
Enumeration Date | 2006-03-12 |
Last Update Date | 2007-07-08 |