| NPI | 1619486511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02305200) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00270700) |
| 146N00000X Emergency Medical Technician, Basic (Licence: CA E130955) | |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2024-11-25 |