| NPI | 1306777107 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2026-05-28 |
| Last Update Date | 2026-05-28 |