| NPI | 1144282252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NJ 40QA01381100) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2011-01-20 |