| NPI | 1942607312 |
|---|---|
| Former Name | LOGAN ANTHONY BRYANT |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MS AT0711) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-01 |