| NPI | 1487425468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2024-01-10 |