| NPI | 1184161325 |
|---|---|
| Former Name | EMILY LEBLANC |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2019-08-12 |