| NPI | 1316334733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 2000025437) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NJ 608409) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2016-09-19 |