| NPI | 1386234078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 227900000X Respiratory Therapist, Registered | |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2022-02-18 |