| NPI | 1992804942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00128100) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00220800) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001963-1) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2014-07-30 |