NPI | 1881712339 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 455) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT 000494) |
Enumeration Date | 2007-03-26 |
Last Update Date | 2015-05-14 |