NPI | 1871966317 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NY 001450-1) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: FL AL2581) |
Enumeration Date | 2015-11-05 |
Last Update Date | 2015-11-05 |