| NPI | 1528650751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00283300) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NJ 641258) |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2021-02-27 |