NPI | 1962968255 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NM AT-2023-0007) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
2255A2300X Specialist/Technologist Athletic Trainer | |
Enumeration Date | 2019-02-12 |
Last Update Date | 2024-01-18 |