| NPI | 1750908463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2020-06-29 |