| NPI | 1043941974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 363A00000X Physician Assistant (Licence: NY 029126) | |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2022-10-17 |