| NPI | 1891767901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00062100) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT001246A) |
| 146N00000X Emergency Medical Technician, Basic | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2012-06-27 |