| NPI | 1770962326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 226300000X Kinesiotherapist (Licence: NJ 1357611112) |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2017-01-05 |