| NPI | 1336518943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: PA 17-0629) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT006128) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2018-08-24 |