| NPI | 1043687551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00207900) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: NJ 25mt00207900) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2026-05-23 |