| NPI | 1770124646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000007469) |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2019-10-02 |