| NPI | 1013532357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00315800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02176600) |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2024-04-18 |