NPI | 1740556950 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CO AT.0001179) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2012-04-02 |
Last Update Date | 2015-02-19 |