| NPI | 1487667648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA.08816) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2014-06-07 |