| NPI | 1760167928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 225400000X Rehabilitation Practitioner | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 227900000X Respiratory Therapist, Registered | |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2023-06-15 |