| NPI | 1366004095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2021-09-21 |