Individual
ETHAN PAUL BRODER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1101 STANFORD DR, CORAL GABLES, FL 33146-2001
(203) 885-6489
Mailing address
1101 STANFORD DR, CORAL GABLES, FL 33146-2001
(203) 885-6489
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/08/2017
Last updated
11/08/2017
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