| NPI | 1942387717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WX0800X Registered Nurse, Orthopedic (Licence: NC 276949) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-2875) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-08-04 |