| NPI | 1336603620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2024-02-19 |