| NPI | 1942742127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NY 045238) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01869400) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00224500) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003238) | |
| Enumeration Date | 2016-11-05 |
| Last Update Date | 2021-04-13 |