NPI | 1972912368 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1564) |
Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MA 885343) |
Enumeration Date | 2014-08-11 |
Last Update Date | 2014-08-11 |