NPI | 1992798367 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000097) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT002430A) |
Enumeration Date | 2005-08-31 |
Last Update Date | 2007-07-08 |