| NPI | 1861211757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2278E1000X Respiratory Therapist, Certified Educational |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| Enumeration Date | 2024-10-08 |
| Last Update Date | 2024-10-08 |