| NPI | 1538277371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00060600) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00115800) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2008-06-10 |