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Individual
PETER SMITH
Active
Individual
PETER SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AH748AT
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AH748AT
ALLIED HEALTH STATE LICENSE
MA
Enumeration date
11/30/2017
Last updated
06/16/2018
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