| NPI | 1124827423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-03-10 |