NPI | 1982159216 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126003148) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1796) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2849) | |
Enumeration Date | 2016-08-16 |
Last Update Date | 2021-08-12 |