| NPI | 1194706119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH PTA02598) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT000167) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2025-09-11 |