| NPI | 1720830052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 101200000X |
| 225800000X Recreation Therapist | |
| 106S00000X Behavior Technician | |
| 133NN1002X Nutritionist Nutrition, Education | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2024-04-07 |