NPI | 1962477869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1021) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT1903) |
Enumeration Date | 2006-02-22 |
Last Update Date | 2021-07-26 |