NPI | 1588781330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT000739) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2007-03-26 |
Last Update Date | 2020-05-08 |