| NPI | 1316289879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126002239) |
| Additional Taxonomies | 225500000X Specialist/Technologist |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: 13-0840) | |
| 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2019-02-28 |