| NPI | 1366415697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OH 07828) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH 002820) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2010-10-22 |