| NPI | 1215762851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: 4143-3128-0583) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2024-09-04 |