NPI | 1871852731 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NM 539) |
Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: GA 11-0619) |
Enumeration Date | 2012-05-14 |
Last Update Date | 2013-04-02 |