NPI | 1871968834 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-2677) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 030802104) |
Enumeration Date | 2015-12-02 |
Last Update Date | 2017-01-13 |