NPI | 1093176547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 106014) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-03-11 |
Last Update Date | 2020-09-18 |