NPI | 1801073861 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 698) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 438) |
Enumeration Date | 2008-01-22 |
Last Update Date | 2011-02-22 |