{
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"EIN": null,
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"FirstLineMailingAddress": "8030 LAKEPOINTE DR",
"SecondLineMailingAddress": "BLDG #2",
"MailingAddressCityName": "PLANTATION",
"MailingAddressStateName": "FL",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "3301 COLLEGE AVE",
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"PracticeLocationAddressCityName": "DAVIE",
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"PracticeLocationAddressCountryCode": "US",
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"EnumerationDate": "03/12/2007",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Athletic Trainer",
"LicenseNumber": "AL 1912",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}