| NPI | 1760289938 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT007261) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2026-06-02 |