| NPI | 1962972372 |
|---|---|
| Former Name | JUAN CARLOS HERNANDEZ |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000018330) |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2018-11-28 |