| NPI | 1477016327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: OH PT.015069) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: SC 8403) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC BOC154302) | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2019-08-07 |