| NPI | 1265549935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT003228) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH PT003228) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT000656) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2013-06-03 |