NPI | 1750668141 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA A160590112) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36002146A) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.002661) | |
Enumeration Date | 2011-11-14 |
Last Update Date | 2020-08-13 |