| NPI | 1144608688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01684000) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 002214) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00221600) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2016-10-31 |