NPI | 1922028182 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: FL AL 1872) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TN 910) |
Enumeration Date | 2006-07-20 |
Last Update Date | 2007-07-08 |