| NPI | 1760046767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT735) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: ME 19-0208) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2019-04-24 |