NPI | 1912396839 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT.003788) |
Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OH 0157021) |
Enumeration Date | 2015-01-15 |
Last Update Date | 2015-01-15 |