| NPI | 1831274273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT0090400) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: NJ 25mt00090400) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2014-08-06 |