NPI | 1780979328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 2212) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 1393) |
Enumeration Date | 2011-06-11 |
Last Update Date | 2024-06-10 |