NPI | 1831999119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL7022) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA Pending) |
Enumeration Date | 2025-03-17 |
Last Update Date | 2025-03-17 |