| NPI | 1801455712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2023-01-23 |