| NPI | 1275916371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA 2000021474) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: GA 22-1115) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2023-04-19 |