| NPI | 1447714498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00025600) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NJ 40QA00620600) |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2019-01-24 |