| NPI | 1235884180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 293310) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 2279P1005X Respiratory Therapist, Registered, Pulmonary Rehabilitation | |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2024-11-01 |