| NPI | 1982142279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 226000000X Recreational Therapist Assistant |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |