| NPI | 1508334855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: IL 475909) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2020-11-20 |