| NPI | 1598351173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 2279E0002X Respiratory Therapist, Registered, Emergency Care |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2020-12-17 |