| NPI | 1750858429 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225100000X Physical Therapist | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2024-05-16 |