| NPI | 1033932298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2024-11-06 |
| Last Update Date | 2026-08-24 |