NPI | 1831441732 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0000430) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00177000) |
Enumeration Date | 2012-10-03 |
Last Update Date | 2012-10-03 |