| NPI | 1154669513 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00172100) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NJ 577321) |
| Enumeration Date | 2013-01-19 |
| Last Update Date | 2013-01-19 |