| NPI | 1609319599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01706700) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2019-05-30 |