NPI | 1952367260 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 00116) |
Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: IA B-08-241-27) |
Enumeration Date | 2006-04-25 |
Last Update Date | 2025-09-11 |