| NPI | 1881054237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant |
| Enumeration Date | 2016-02-27 |
| Last Update Date | 2023-12-25 |