NPI | 1366915464 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 3239) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL5725) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 1169) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-01-10 |
Last Update Date | 2025-03-10 |