NPI | 1760904213 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CT 001239) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: PA RT006757) |
Enumeration Date | 2017-07-15 |
Last Update Date | 2023-09-26 |